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Accuracy of screening methods of COVID-19 in pregnancy: a cohort study
Muhammad I Aldika Akbar1,2, Khanisyah E Gumilar3, Eccita Rahestyningtyas3
1Department Obstetrics and Gynecology, Faculty of Medicine, Airlangga University, Surabaya, Indonesia - muhammad-i-a-a@fk.unair.ac.id.
Insights
Screening pregnant women for COVID-19 using clinical symptoms, rapid antibody tests, chest X-rays, and neutrophil-to-lymphocyte ratio (NLR) can identify high-risk cases. This approach reduces the need for reverse transcriptase polymerase chain reaction (RT-PCR) testing in resource-limited settings.
Area of Science:
- Medical Diagnostics
- Infectious Diseases
- Obstetrics & Gynecology
Background:
- Universal screening for Coronavirus Disease 2019 (COVID-19) in laboring pregnant women is recommended during pandemics.
- Limited availability of reverse transcriptase polymerase chain reaction (RT-PCR) tests necessitates alternative screening methods in low-middle income countries.
- This study evaluates the accuracy of various COVID-19 screening methods in pregnant women.
Purpose of the Study:
- To assess the diagnostic accuracy of clinical signs and symptoms, rapid antibody tests, chest X-ray findings, and neutrophil-to-lymphocyte ratio (NLR) for COVID-19 in pregnant women.
- To compare the effectiveness of these screening methods against RT-PCR confirmation.
- To identify a reliable, resource-efficient screening strategy for pregnant women during the COVID-19 pandemic.
Main Methods:
- A cohort of 141 pregnant women with suspected COVID-19 was recruited.
- Participants were categorized into COVID-19 positive and negative groups based on RT-PCR results.
- Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DOR) were calculated for each screening parameter.
Main Results:
- Neutrophil-to-lymphocyte ratio (NLR) >5.8 showed the highest diagnostic accuracy (70.81%) among the evaluated parameters.
- Clinical signs and symptoms (65.87%) and chest X-ray (58.76%) also demonstrated moderate diagnostic accuracy.
- Rapid antibody tests had low specificity (35.06%) and diagnostic accuracy (36.53%).
Conclusions:
- Combined screening methods, particularly incorporating NLR, can effectively identify high-risk pregnant women for COVID-19 prior to RT-PCR confirmation.
- This strategy can significantly reduce the reliance on RT-PCR testing in resource-limited settings.
- Accurate initial screening is crucial for timely management and resource allocation in pandemic situations involving pregnant populations.
Background:
All pregnant women in labor should be universally screened for Coronavirus Disease 2019 (COVID-19) during pandemic periods using reverse transcriptase polymerase chain reaction (RT-PCR) test. In many low-middle income countries, screening method was developed as an initial examination because of limited availability of RT-PCR tests. This study aims to evaluate the screening methods of COVID-19 accuracy in pregnant women.
Methods:
We recruited all pregnant women with suspicion of COVID-19 from April to August 2020 at Airlangga University Hospital, Surabaya, Indonesia. The participant was divided into two groups based on RT-PCR results: COVID-19 and non-COVID-19 group. The proportion of positive signs and symptoms, rapid antibody test, abnormal findings in chest X-ray, and neutrophil to lymphocyte ratio (NLR) value were then compared between both groups. The sensitivity, specificity, positive predictive value (PPV), negative predictive values (NPV), and diagnostic accuracy (DOR) were calculated.
Results:
A total 141 pregnant women with suspected COVID-19 cases were recruited for this study. This consist of 62 COVID-19 cases (43.9%) and 79 non-COVID-19 pregnant women (56.1%). The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of each parameter are as follow: clinical sign and symptoms (24.19%, 75.95%, 3.92%, 96.11%, 65.87%), rapid antibody test (72.73%, 35.06%, 4.35%, 96.94%, 36.53%), chest X-ray (40.68%, 59.45%, 3.92%, 96.11%, 58.76%), and NLR >5.8 (41.38%, 72%, 5.66%, 96.80%, 70.81%).
Conclusions:
The use of combined screening methods can classify pregnant women with high-risk COVID-19 before definitively diagnosed with RT-PCR. This practice will help to reduce RT-PCR need in a limited resources country.
